Establishing "normal" values for liver function tests after reconstruction of biliary injuries.
BACKGROUND
Abnormalities of liver function tests (LFT) are sometimes taken as evidence of a less than optimal result after repair of a biliary injury. Rather than indicating liver or anastomotic dysfunction, moderate LFT elevations can be "normal" for these patients. This study's aim was to determine LFT reference values after biliary-enteric anastomosis for biliary injury repair in persons who have had an excellent postoperative course for > 6 months.


METHODS
Of 113 patients repaired, 73 were identified with the following characteristics: LFT available at > or = 6 months after repair, no biliary tract symptoms, no underlying liver disease, and biliary injury sustained during cholecystectomy. Outside LFT results were standardized to Barnes-Jewish Hospital reference values. One set of LFT per patient was collected at the following times points after repair: 6 months to 2 years, 2 to 5 years, and > 5 years.


RESULTS
For each distribution, the 97.5(th) p97.5ercentile values for alkaline phosphatase (> or = 166 IU/L) and total bilirubin (> or = 1.3 mg/dL) were elevated relative to Barnes-Jewish Hospital standard values. Values for alanine aminotransferase and aspartate aminotransferase were more variable.


CONCLUSIONS
Moderate LFT elevations exceeding standard reference values are common after repair of a biliary injury in patients who have had excellent results. Alkaline phosphatase values fall with time after repair so that comparisons should take into account time from repair. Values < or = 97.5(th) percentile limits described here should not be taken as evidence of liver or anastomotic dysfunction.
Fialkowski
Elizabeth A
EA
Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
Winslow
Emily R
ER
Scott
Mitchell G
MG
Hawkins
William G
WG
Linehan
David C
DC
Strasberg
Steven M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D002763:Cholecystectomy / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007582:Jejunostomy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D013997:Time Factors; D000637:Transaminases / Q000097:blood*
D000637:Transaminases; D000469:Alkaline Phosphatase; D001663:Bilirubin